The aim of this study was to explore and analyse midwives' rationales for their
decision-making in everyday situations.
Design
A symbolic interactionist study underpinned by Blumer's Symbolic
Interactionism
Setting
Midwifery practice areas in Central and Southern Scotland
Methods
Midwives were sampled purposively for age, experience and area of practice.
Nineteen midwives took part from a variety of practice areas and three different
regions in Scotland. Data collection comprised clinical observation of midwives
making decisions in a variety of midwifery practice, use of validated interactive
scenarios and in-depth interviews based on the observation field notes. Data
were analysed using Blumer's principles of Symbolic Interactionism (Blumer,
1969), his concepts of 'self' and 'other' along with Ritchie and Spencer's (1994)
five stage framework analysis.
Findings
The analysis of the data identified four rationales for midwives' decision-making.
The first rationale was the individuality of the midwives, as related to Blumer's
self 'I'. The second and third rationales were professional persona and
compliance with policy and regulation, which were associated with Blumer's self
'me'. The final rationale was the individuality of women and babies, which is
affiliated to Blumer's 'other'.
Conclusions
The individuality of the midwives and women was a major rationale for the
decisions made. Individuality as a component of decision-making has not been
well explored, and would benefit from further investigation within the research
field of midwives' decision-making. Professional persona and compliance were
also important rationales for the midwives' decisions. Midwifery and NHS
culture influenced midwives in their actions, and these are issues that need to
be examined more closely if midwives are to remain autonomous practitioners.